Healthcare Provider Details

I. General information

NPI: 1053357830
Provider Name (Legal Business Name): RLS SUPERMARKETS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 HARWOOD RD
BEDFORD TX
76021-3904
US

IV. Provider business mailing address

3300 HARWOOD RD
BEDFORD TX
76021-3904
US

V. Phone/Fax

Practice location:
  • Phone: 817-540-3131
  • Fax: 817-685-8905
Mailing address:
  • Phone: 817-540-3131
  • Fax: 817-685-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number29913
License Number StateTX

VIII. Authorized Official

Name: JOHN PIPER
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 972-754-4436